Differences Between Takotsubo and the Working Diagnosis of Myocardial Infarction With Nonobstructive Coronary Arteries

• Published in: Frontiers in cardiovascular medicine 2022-03, Vol.9, p.742010-742010
• Main Authors: Lopez-Pais, Javier, Izquierdo Coronel, Bárbara, Raposeiras-Roubín, Sergio, Álvarez Rodriguez, Leyre, Vedia, Oscar, Almendro-Delia, Manuel, Sionis, Alessandro, Martin-Garcia, Agustin C, Uribarri, Aitor, Blanco, Emilia, Martín de Miguel, Irene, Abu-Assi, Emad, Galán Gil, David, Sestayo Fernández, Manuela, Espinosa Pascual, Maria Jesús, Agra-Bermejo, Rosa María, López Otero, Diego, García Acuña, Jose María, Alonso Martín, Joaquín Jesús, Gonzalez-Juanatey, Jose Ramón, Perez de Juan Romero, Miguel Ángel, Núñez-Gil, Iván J
• Format: Article
• Language: English
• Subjects: Cardiovascular Medicine; definition; MINOCA; prognosis; Takotsubo; working diagnosis
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2022.742010

Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCAs) is still controversial. The aim of this work was to evaluate the main differences between TTS and non-TTS MINOCAs. A cohort study based on two prospective registries: TTS from the RETAKO registry ( :1,015) and patients with non-TTS MINOCAs from contemporary records of acute myocardial infarction from five 5 national centers ( :1,080). Definitions and management recommended by the ESC were used. Survival analysis was based on the Cox regression analysis; propensity score matching (PS) was created to adjust prognostic variables. Takotsubo syndrome were more often women (85.9 vs. 51.9%; < 0.001) and older (69.4 ± 12.5 vs. 64.5 ± 14.1 years; < 0.001). Atrial fibrillation (AF) was more frequent in non-TTS MINOCAs (10.4 vs. 14.4%; = 0.007). Psychiatric disorders were more prevalent in TTS (15.5 vs. 10.2%, < 0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs. 1.8%, ( = 0.015), and 25.8 vs. 11.5%, ( < 0.001). Global mortality before PS matching was 16.1% in non-TTS MINOCAs and 8.1% in TTS. Median follow-up was 32.4 months; after PS matching, TTS had fewer major adverse cardiovascular events (MACEs): hazard ratio (HR) 0.59; 95% CI 0.42-0.83. There were no differences in global mortality (HR 0.87; CI: 0.64-1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35-0.98). Compared to the rest of MINOCAs, TTS presents a different patient profile and a more aggressive acute phase. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a separate entity with unique characteristics and prognosis.